Method and apparatus for the external fixation and correction of bone

ABSTRACT

An external fixation device includes a frame assembly having a first arc segment and a second arc segment. The first arc segment is for interconnection to a first bone portion. The second arc segment is for interconnection to a second bone portion. The first arc segment is coupled to the second arc segment for relative rotation. The external fixation assembly additionally includes an articulating module. The articulating module includes a central member, a first pivot segment and a second pivot segment. The first pivot segment is coupled to the central member for driven rotation about a first pivot axis. The second pivot segment is coupled to the central member for driven rotation about a second pivot axis. The second pivot axis is substantially perpendicular to the first pivot axis.

CROSS-REFERENCE TO RELATED APPLICATION

This application claims priority to a provisional patent applicationwhich has been assigned U.S. Ser. No. 60/395,814, filed Jul. 15, 2002.

FIELD OF THE INVENTION

The present invention relates to the external fixation of bones duringorthopedic surgical applications, such as the repair of bone fracturesand the correction of bone defects. More particularly, the presentinvention relates to a method and apparatus which allow for gradual andcontrolled correction of bone deformities and malunions. The variousapplications of the present invention involve gradual angular,translational and rotational correction of bone deformities andmalunions.

BACKGROUND OF THE INVENTION

In various orthopedic surgical procedures, it is necessary to secure twobone portions in a relatively fixed relationship to each other. Forexample, the need for establishing such a secured relationship is oftena result of a fracture which has occurred to the bone. This securedrelationship is also employed to correct deformities and malunions. Toensure that the bone can regenerate in the proper orientation and fusethe fracture, it is important that the bone portions be fixed and in thedesired position during bone regeneration.

Various external fixation devices for the repair of traumatized bone areknown. For example, commonly assigned U.S. Pat. No. 5,662,650 to Baileyet al. discloses an apparatus for the external fixation of large bones.The apparatus is illustrated to include a main body as well as a firstand second bone screw clamps. The main body serves to allow theapparatus to axially rotate, thereby providing a proper longitudinalrotational location of the bone screws with respect to a bone. The firstbone screw clamp is used to secure a first bone screw to the apparatuswhile permitting the first bone screw to be axially displaced from themain body. In a similar fashion, the second bone screw clamp functionsto secure a second bone screw to the apparatus and to allow the secondbone screw to be axially displaced with respect to the main body. U.S.Pat. No. 5,662,650 is incorporated by reference as if fully set forthherein.

In certain orthopedic surgical procedures, it is necessary to engage twobone portions in a fixed relationship and to angulate, rotate and/ortranslate the two bone portions relative to each other. The need formaking such an adjustment is frequently the result of bone deformity.Such bone deformities may result from congenital defects including butnot limited to Blount's Disease, Tibia Vara, and HypophosphatemicRickets. Adjustment of bone portions may also be required as a result ofpost-traumatic applications, such as the correction of bone malunions.

Other known devices are available for the correction of bone deformitiesand malunions. For example, commonly assigned U.S. Pat. No. 5,941,879discloses an external fixator for adjustably securing a first boneportion in a position relative to a second bone portion. The fixatorincludes a first clamping assembly for receiving a first bone screwconnected to the first bone portion and a second clamping assembly forreceiving a second bone screw connected to the second bone portion. Thefirst and second clamping assemblies are interconnected by a connectionmember. The external fixator also includes a drive unit for controllingangular adjustment of the second clamping assembly relative to the firstclamping assembly.

While the fixators specifically for correcting bone deformities andmalunions of the type described above may have proven acceptable forcertain applications, such fixators are nevertheless susceptible toimprovements that may enhance the performance of the fixator forparticular applications.

SUMMARY OF THE INVENTION

In general, the present invention relates to the external fixation ofbones. More specifically, the present invention relates to an externalfixator which is operable to adjustably secure a first bone portion in aparticular position with respect to a second bone portion.

An advantage of the present invention is the provision of a method andapparatus for the external fixation of bone which allows the rate ofangular, rotational and/or translational correction of bone deformitiesand malunions to be easily and more accurately controlled.

In one particular form, the present invention provides a frame assemblyfor an external fixation device. The frame assembly includes a first arcsegment and a second arc segment. The first arc segment is forinterconnection to a first bone portion. The second arc segment is forinterconnection to a second bone portion. The first arc segment iscoupled to the second arc segment for controlled relative rotation.

In another particular form, the present invention provides anarticulating module for an external fixation device. The articulatingmodule includes a central member, a first pivot segment and a secondpivot segment. The first pivot segment is coupled to the central memberfor driven rotation about a first pivot axis. The second pivot segmentis coupled to the central member for driven rotation about a secondpivot axis. The second pivot axis is substantially parallel to the firstpivot axis.

In yet another particular form, the present invention provides a methodof correcting a rotational deformity or malunion of a bone having alongitudinal axis. The method includes the step of providing an externalfixation device including a frame assembly with a first arc segmentcoupled to a second arc segment. The method additionally includes thesteps of interconnecting the first arc segment to a first bone portionand interconnecting the second arc segment to a second bone portion. Themethod further includes the step of rotating the first arc segmentrelative to the second arc segment to correct the rotational deformityor malunion of the bone.

Additional advantages and features of the present invention will becomeapparent from the following description and appended claims, taken inconjunction with the accompanying drawings.

BRIEF DESCRIPTION OF THE DRAWINGS

The present invention will become more fully understood from thedetailed description and the accompanying drawings, wherein:

FIG. 1 is an environmental view of an apparatus for the externalfixation and correction of bone according to the teachings of apreferred embodiment of the present invention, the apparatus shownoperatively associated with a human tibia.

FIG. 1A is a perspective view of a portion of the apparatus according tothe teachings of the preferred embodiment of the present invention.

FIG. 2 is a top view of a first frame assembly of the external fixationand correction of bone according to the teachings of the preferredembodiment of the present invention.

FIG. 2A is a cross-sectional view taken along the line 2A-2A of FIG. 2.

FIG. 3 is a side view of an articulating module of the apparatusaccording to the teachings of the preferred embodiment of the presentinvention.

FIG. 4 is another side view of the articulating module of the apparatusaccording to the teachings of the preferred embodiment of the presentinvention.

FIG. 5 is a cross-sectional view taken along the line 5-5 of FIG. 3.

FIG. 6 is a perspective view of a central member of the articulatingmodule of the apparatus according to the teachings of the preferredembodiment of the present invention.

FIG. 7 is a side view of a first pivot segment and an associatedtranslation module of the articulating module of the apparatus accordingto the teachings of the preferred embodiment of the present invention.

FIG. 8 is a top view of the first pivot segment and associatedtranslation module of FIG. 7.

FIG. 9 is a side view of a second pivot segment and an associatedtranslation module of the articulating module of the apparatus accordingto the teachings of the preferred embodiment of the present invention.

FIG. 10 is a top view of the second pivot segment and associatedtranslation module of FIG. 9.

FIG. 11 is a side view of a bone screw clamping assembly of theapparatus according to the teachings of the preferred embodiment of thepresent invention.

FIG. 11A is an end view of the bone clamping assembly of FIG. 11.

FIG. 12 is a partially exploded side view of a mounting member forconnecting the bone screw clamping assembly with a first frame assemblyof the apparatus according to the teachings of the preferred embodimentof the present invention.

FIG. 13 is a side view of a rail member of the apparatus according tothe teachings of the preferred embodiment of the present invention.

FIG. 14 is an end view of a second frame assembly of the apparatusaccording to the teachings of the preferred embodiment of the presentinvention.

FIG. 15 is a cross-sectional view taken along the line 15-15 of FIG. 14.

FIG. 16 is a side view of the second arc segment of the apparatusaccording to the teachings of the preferred embodiment of the presentinvention.

FIG. 16A is a side view of the second arc segment similar to FIG. 16,the worm gear removed for purposes of illustration.

FIG. 17 is an enlarged end view of the second arc segment shownpartially cutaway for purposes of illustration.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENT

The following description of the preferred embodiment(s) is merelyexemplary in nature and is in no way intended to limit the invention,its application, or uses.

With general reference to FIGS. 1 through 17 of the drawings, anapparatus for the external fixation and correction of a bone constructedin accordance with the teachings of a preferred embodiment of thepresent invention is illustrated and generally identified at referencecharacter 10. With particular reference to the environmental view ofFIG. 1, the apparatus 10 is shown connected to a bone 12 through aplurality of bone screws 14 which serve to secure a first bone portion12 a relative to a second bone portion 12 b.

In the exemplary application illustrated, the first and second boneportions 12 a and 12 b secured by the apparatus 10 are of a single bone12. The bone 12 shown in the drawings represents a human tibia. It is tobe understood, however, that the apparatus 10 may be operativelyattached to a variety of other types of bones and used to correct bonedeformities, correct malunions, or repair fractures. As will becomeapparent below, by securing the first and second bone portions 12 a and12 b with the apparatus 10 of the present invention, the orientation ofthe first portion 12 a relative to the second portion 12 b may beangularly, rotationally, and translationally adjusted.

In the particular construct shown, the apparatus 10 is illustrated togenerally include first and second frame assemblies 16 and 18interconnected by an articulating module or adjustable module 20. Theparticular construct shown is further illustrated to include a bonescrew clamping assembly 24. The second frame assembly is secured to thefirst bone portion 12 a. The bone screw clamping assembly 24 is securedto the second bone portion 12 b. The bone screw clamping assembly 24 iscoupled to the first frame assembly 16. The first and second frameassemblies 16 and 18 are adjustably interconnected by the module 20.

As will become apparent to those of ordinary skill in the art, theteachings of the present invention may be employed in many differentconstructs for external fixation depending on the particular surgicalapplication and further depending on surgeon preferences. The constructshown in the drawings will be understood to be merely exemplary. Thevarious components of the apparatus 10 of the present invention may bealternatively utilized in different constructs involving some or all ofthe illustrated components. Additionally, the various components of thepresent invention may be used in connection with other components, someof which are commercially available from the assignee of the subjectapplication under the registered trademark DynaFix®.

The first frame assembly 16 defines an arc segment. In the embodimentillustrated, the first frame assembly 16 is shown to only partiallycircumscribe the bone 12. As shown most clearly in FIGS. 2 and 2A, thefirst frame assembly 16 defines approximately one-third of a completecircle. Alternatively, the first frame assembly 16 can be configured todefine more or define less of an incomplete circle or configured as acomplete ring to fully circumscribe the bone 12. The first frameassembly 16 is formed to include tabs 21 to facilitate attachment toadditional segments (not shown). This arrangement and manner ofattachment is more fully described in commonly assigned U.S. Pat. No.5,997,537 which is hereby incorporated by reference as if fully setforth herein.

The first frame assembly 16 is formed to include a plurality ofapertures 22 to facilitate attachment of the module 20 in a manner to bemore fully addressed below. The first frame assembly 16 is further shownto define a groove 26 in an outer peripheral face to facilitateattachment of clamping elements. In the application illustrated, noclamping elements are employed for directly connecting the first frameassembly 16 to the bone 12.

With particular reference to FIGS. 11, 11A and 12, the bone screwclamping assembly 24 is shown to include a main body having a baseportion 30 and a cover portion 32. The base portion 30 serves to receivea bone screw 14 in one of a plurality of grooves 34. The cover portion32 serves to secure the bone screw 14 within the groove 34.

The cover portion 32 of the bone screw clamping assembly 24 is securedto the base portion 30 by two screws 36. To accommodate these screws 36,the cover portion 32 of the bone screw clamping assembly 24 includes twoapertures 38 which mate with corresponding apertures 40 in the baseportion 30 of the bone screw clamping assembly 24. Accordingly, uponsecured threaded engagement of the screws 36 within the apertures 38 and40, the cover portion 32 of the bone screw clamping assembly 24 may besecured to the base portion 30 of the bone screw clamping assembly 24.

With additional reference to FIG. 13, to provide for translation of thebone screw clamping assembly 24 relative to the first frame assembly 16,the bone screw clamping assembly 24 further includes a rail member 42.The rail member 42 preferably includes a D-shaped extension 48 which isable to be received in a D-shaped bore 50 of the bone screw clampingassembly 24. The D-shaped extension 48 includes an elongated slot 51 forreceiving a set screw (not particularly shown) that extends through athreaded aperture 52 provided in the base portion 30. Because of thecross-sectional shape of the D-shaped extension 48, the base portion 30of the bone screw clamping assembly 24 is able to slide on the extension48 of the rail member 42. However, the base portion 30 is unable torotate with respect to the D-shaped extension 48.

The rail member 42 has a generally circular end 53 defining acylindrical aperture 54. The cylindrical aperture 54 receives acylindrical portion 55 of a mounting member 56 (shown specifically inFIG. 12). The cylindrical portion 55 defines a reduced diameter groove58 that receives a set screw 60 extending through an aperture 62 of theend 53.

A pair of threaded fasteners 64 extend through apertures 22 of the firstframe assembly 16 and engage threaded apertures 66 of the mountingmember 56. Prior to complete tightening of the set screw 60, the railmember 42 and thereby the clamp 24 are able to rotate about an axisparallel to the bone segment 12 b.

With particular reference now to FIGS. 1 and 14 through 17, the secondframe assembly 18 of the apparatus 10 constructed in accordance with theteachings of a preferred embodiment of the present invention will befurther described. It will become apparent to those skilled in the artthat the second frame assembly is specifically intended for thetreatment of rotational deformities of bone. In other applications, itmay be desirable to alternative use a frame assembly substantiallyidentical to the first frame assembly 16 in place of the second frameassembly 18.

In the environmental view of FIG. 1, the second frame assembly 18 isshown operatively associated with a plurality of clamp members 70 andassociated bone screws 14 for securing the second frame assembly 18 tothe bone 12. The clamps 70 shown in FIG. 1 of the drawings engage anouter peripheral groove (similar in geometry to the groove 26 of thefirst frame assembly 16) of the second frame assembly 18 and illustrateone particular manner for attachment of the second frame assembly 18 tothe bone 12. It will be understood by those skilled in the art that theparticular manner of attachment of the second frame assembly 18 to thebone 12 is beyond the scope of the present invention and may beaccomplished in any well known manner. One suitable manner of attachmentis shown and described in commonly assigned U.S. Pat. No. 5,997,537.

The second frame assembly 18 of the preferred embodiment of the presentinvention is generally illustrated to include a first arc segment ormember 72 and a second arc segment or member 74. The first and secondarc segments 72 and 74 are coupled to one another for relative rotation.In the embodiment illustrated, the first and second arc segments 72 and74 are concentrically arranged and the first arc segment 72 isillustrated as an inner arc segment. Similarly in this regard, thesecond arc segment 74 is illustrated as an outer arc segment.

As with the first frame assembly 16, the first arc member 72 of thesecond frame assembly 18 is formed to include a plurality of apertures76 to facilitate connection to the module 20.

Further similar to the first frame assembly 16, the first and second arcsegments 72 and 74 extend through approximately one-third of a completecircle. Alternatively, the first and second arc segments can beconfigured to define more or less of an incomplete circle or configuredas a complete ring to fully circumscribe the bone 12.

As particularly shown in the cross-sectional view of FIG. 15, the firstarc segment 72 has a main portion 78 having a downwardly openingU-shape. A upper horizontal segment connects two downwardly extendinglegs and defines the apertures 76. The first arc segment 72 further hasa generally T-shaped extension 80 outwardly extending from the mainportion 78. The T-shaped extension 80 is slidably received within acooperative recess 82 of the second arc segment 72.

The second frame assembly 18 preferably includes a drive unit 84 forgradual and controlled rotation of the second arc segment 16 relative tothe first arc segment 72. In the embodiment illustrated, the drive unit84 includes a housing or cover 86 secured to the second arc segment 74with a pair of fasteners 88. The drive unit 84 further includes a wormor worm gear 90. The worm gear 90 is rotatably carried by the second arcsegment 74 and substantially disposed in the outer peripheral groovedefined by the second arc segment 74. The second arc segment 74 isgenerally I-shaped. A vertically extending portion 92 of the second arcsegment 74 defines an opening 94 (see FIG. 16A). The worm gear 90includes a threaded portion 96. The threads of the threaded portion 96partially extend through the opening 94 and a plurality of teeth 98provided on an arcuate exterior portion of the first arc segment 72. Inthe embodiment illustrated, the plurality of teeth 98 are formed on anouter peripheral side of the T-shaped portion 80 and extend along theentire length of the first arc segment 72 to facilitate relativerotational movement between the first and second arc segments 72 and 74.A pin 100 (see FIG. 16) retains the worm gear 90 from translatingrelative to the second arc segment 74.

The common centers of curvature of the first and second arc segments 72and 74 of the second frame assembly define a rotational axis about whichthe first bone portion 12 a can be rotated relative to the second boneportion 12 b. Significantly, this rotational axis can be postionedgenerally coincident with a long axis of the bone 12. Relative movementbetween the bone segments 12 and 12 b is gear driven and therebycontrolled and gradual.

With particular reference to FIGS. 1 and 1A and FIGS. 3 through 10, themodule 20 of the preferred embodiment of the present invention will nowbe further described. The module 20 is generally illustrated to includea pair of mounting portions 102, a pair of translation segments 104, afirst pivot segment 106, a second pivot segment 108 and a central member110. The term “central” used to describe the central member 110 will beunderstood to reference the central location of the member 110 betweenthe first and second pivot segments 106 and 108. The central member 110need not be located centrally within the module 20.

A first of the mounting portion 102 functions to connect the module 20with the first frame assembly 16. A second of the mounting portions 102similarly functions to connect the module 20 with the second frameassembly 18. In the embodiment illustrated, the mounting portions 102will be understood to be identical. The mounting portions 102 areillustrated to generally include a plate portion 112 and a single postor mounting member 114. The post 114 passes through one of the aperturesof the respect frame assembly 16 or 18 and threadably engages anaperture 116 of the plate member 112. Insofar as interconnection of themodule 20 with the frame assemblies 16 or 18 is made by a single post114, relative rotation between the mounting members 102 and theremainder of the module 20 is not necessary. In this regard, the post114 defines an axis about which the module 20 can rotate prior tocomplete tightening.

The translation segments 104 will be understood to be identical. Asperhaps most clearly shown in the environmental view of FIG. 5, thetranslation segments 104 defines a groove 118 for slidably receiving aportion of the associated plate member 112. The translation segments 104define a generally rectangular opening 120 and include a threaded worm122. In the embodiment illustrated, the plate members 112 of themounting portions 102 include a rectangular extension or carriage 124.These rectangular extensions 124 define the apertures 116 for receivingthe posts 114. The worm 122 threadably engages an aperture 126 of therectangular extension 124. The rectangular extension 124 is sized to beslidably received within the opening 120. Rotation of the worm 122 in afirst direction operates to linearly translate the mounting member 102relative to the associated translation segment 104 along an axisparallel to an axis defined by the worm 122.

The worms 122 provide two axes for relative translation between thefirst and second bone portions 12 a and 12 b. The worms 122 of the pairof translation segments 104 are preferably oriented generallyperpendicular to one another. In this manner, the module 20 of thepreferred embodiment of the present invention is able to provide gradualand controlled translation of the first bone portion 12 a relative tothe second bone portion 12 b along two perpendicular axes.

The central member 110 is preferably unitarily constructed. Asparticularly shown in FIG. 6, the central member 110 includes a firstend 130 having an arcuate flange 132. The flange 132 defines a firstplurality of teeth 134. The central member 110 includes a second end 136similarly including an arcuate flange 138 defining a second plurality ofteeth 140. In the embodiment illustrated, the first plurality of teeth134 are disposed in a plane substantially perpendicular to the secondplurality of teeth 140.

The first pivot segment 106 downwardly extends from the uppertranslation segment 104. The first pivot segment 106 is illustrated toinclude a pair of spaced apart flanges 125 and a worm 126. The worm 126threadably engages the first plurality of teeth 134 of the centralmember 110. A pin 142 (shown in FIG. 5) connects the flanges 125 withthe plate central member 110 and defines a secondary pivot axis betweenthe first and second pivot segments 106 and 108 of the module 20. Theflanges 125 are cut-away to accommodate pivoting of the second pivotsegment 108 about the pin 142. A set screw 143 is provided forselectively preventing relative rotation between the first pivotsegement 106 and the central member 110.

The second pivot segment 108 upwardly extends from the lower one of thetranslation segments 104 and similar includes a pair of spaced apartflanges 144 and a worm 146. The worm 146 threadably engages the secondplurality of teeth 140 of the central member 110. A pin 148 passesthrough the flanges 144 of the second pivot segment 108 and connects theflanges 144 with the central member 110. The pin 148 defines a primarypivot axis of the module 20. A set screw 149 is provided for selectivelypreventing relative rotation between the second pivot segment 108 andthe central member 110.

In use, if the primary pivot defined by the pin 148 is exactly alignedwith a pivot point of a bone deformity, no further adjustment of themodule 20 is required. However, if the pivot axis defined by the pin 148is not aligned exactly with the pivot point of the deformity, an angulardeformity in a perpendicular plane and a translational deformity will beobserved. The module 20 is adapted to correct the angle in a planeperpendicular to the primary pivot axis. In addition, the module 20 isadapted to correct translational deformities that may also result if theprimary pivot axis is not exactly aligned with the pivot point of thedeformity.

The module 20 defines two (2) perpendicular axes (i.e., along the pins142 and 148) about which the bone portions 12 a and 12 b may beangulated relative to one another. This relative angulation is geardriven and gradual. Additionally, the module 20 includes twoperpendicular translation axes (i.e., coincident with the worms 122 and146). Again, this translation is gear driven and gradual. Furthermore,rotational axes are defined at the interconnections between the module20 and the frame assemblies 16 and 18 (i.e., along the axis of the posts114).

The description of the invention is merely exemplary in nature and,thus, variations that do not depart from the gist of the invention areintended to be within the scope of the invention. Such variations arenot to be regarded as a departure from the spirit and scope of theinvention.

1-11. (canceled)
 12. An articulating module for an external fixationdevice, the articulating module comprising: a central member; a firstpivot segment coupled to the central member for driven rotation about afirst pivot axis; and a second pivot segment coupled to the centralmember for driven rotation about a second pivot axis, the second pivotaxis being substantially parallel perpendicular to the first pivot axis.13. The articulating module for an external fixation device of claim 12,wherein the central member includes first and second driven portions,the first pivot segment includes a first drive member engaged with thefirst driven portion and the second pivot segment include a second drivemember engaged with the second driven portion.
 14. The articulatingmodule for an external fixation device of claim 13, therein the firstand second driven portions both define a plurality of teeth.
 15. Thearticulating module for an external fixation device of claim 14, whereinthe first and second drive members include first and second worm gearsmeshingly engaging the first and second pluralities of teeth,respectively.
 16. The articulating module for an external fixationdevice of claim 14, wherein the central member is unitarily formed. 17.The articulating module for an external fixation device of claim 16,wherein the first plurality of teeth is oriented substantiallyperpendicularly to the second plurality of teeth.
 18. An articulatingmodule for an external fixation device that includes first and secondmounting members, the articulating module comprising: a central member;first and second translation segments coupled the central member, thefirst and second translation segments coupled to the first and secondmounting members for controlled translation along first and secondtranslation axes, the second translation axis being substantiallyperpendicular to the first translation axis.
 19. The module of claim 18,further comprising first and second pivot segments respectivelyextending from the first and second translation segments, the first andsecond pivot segments pivotably coupled to the central member forcontrolled rotation about respective first and second pivot axes,wherein the first pivot axis is substantially perpendicular to thesecond pivot axis.
 20. The module of claim 18, wherein each of the firstand second translation segments includes a threaded worm meshinglyengaged with the corresponding mounting member for relative translationalong the corresponding translation axis.
 21. The module of claim 19,wherein each of the first and second pivot segments includes a threadedworm meshingly engaged with the central member for relative rotationabout the corresponding pivot axis.
 22. An articulating module for anexternal fixation device, the articulating module comprising: a centralmember; first and second pivot segments coupled to the central memberfor rotation about two perpendicular pivot axes; first and secondmounting members; and first and second translation segments extendingfrom the first and second pivot segments and coupled with the first andsecond mounting members for translation along two perpendicular axes.23. The module of claim 22, wherein each pivot segment includes athreaded worm meshingly engaged with the central member for selectivelycontrolling rotation about the corresponding pivot axis.
 24. The moduleof claim 22, wherein each translation segment includes a threaded wormmeshingly engaged with the corresponding mounting member for selectivelycontrolling translation along the corresponding translation axis. 25.The module of claim 22, wherein each translation segment is slidablyengaged with the corresponding mounting member.
 26. A method ofcorrecting a deformity or fracture or malunion of a bone having alongitudinal axis, the method comprising: attaching first and secondmounting members to the bone; connecting an articulating module to thefirst and second mounting members, the articulating module includingfirst and second translation segments slidably coupled with the mountingmembers, and first and second pivot segments extending from thecorresponding translation segments and pivotably coupled to a centralmember of the module; and rotating the first pivot segment relative tothe central member about a first pivot axis.
 27. The method of claim 26,further comprising translating the first translation member along afirst translation axis relative to the first mounting member.
 28. Themethod of claim 26, further comprising rotating the second pivot segmentrelative to the central member about a second pivot axis, wherein thesecond pivot axis is perpendicular to the first pivot axis.
 29. Themethod of claim 28, further comprising translating the secondtranslation segment along a second translation axis relative to thesecond mounting member, wherein the second translation axis isperpendicular to the first translation axis.
 30. The method of claim 26,wherein rotating the first pivot segment includes controlling rotationwith a threaded worm meshingly engaged with the central member.
 31. Themethod of claim 27, wherein translating the first translation segmentincludes controlling translation with a threaded worm meshingly engagedwith the first mounting member.
 32. The method of claim 28, whereinrotating the second pivot segment includes controlling rotation with athreaded worm meshingly engaged with the central member.
 33. The methodof claim 29, wherein translating the second translation segment includescontrolling translation with a threaded worm meshingly engaged with thesecond mounting member.
 34. A gear mechanism for an external fixationdevice having first and second mounting members, the gear mechanismintegrally formed to include a first plurality of teeth relative towhich the first mounting member is driven about a first pivot axis, anda second plurality of teeth relative to which the second mounting memberis driven about a second pivot axis, wherein the first pivot axis isperpendicular to the second pivot axis.
 35. The gear mechanism of claim34 in combination with the external fixation device.
 36. The gearmechanism of claim 35, wherein the first worm gear is substantiallyperpendicular to the second worm gear.
 37. The gear mechanism of claim34, further comprising means for selectively preventing rotation aboutthe first and second pivot axes.